The Social and Literal Costs of Psychiatric Medicines

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“How have you been feeling lately?,” you are asked.

You pause while trying to say each word carefully. You describe the lack of joy in everyday things, the unwillingness to get out of bed, the sleepless nights and the nightmares that control the few hours you do sleep.

You tell the psychiatrist how you can’t focus because your chest gets so tight that you are afraid you might pass out. Through a shaky voice, you tell a stranger every heartache and stolen moment you can think of.

After for what feels like hours, she finally speaks and says, “What you have is a generalized anxiety disorder, also known as 300.02, paired with a insomnia disorder mostly likely caused by the anxiety, but we will go head and call it 307.42.’’

Your heart stops for a second as she quickly prescribes drugs that you couldn’t pronounce again if you wanted to, and off you go out of the door and she will see you again in three months.

After arriving home with your new medicine with a strange name, you look to your now empty wallet. This strickly business scene is not uncommon. According to Medco Health Solutions and its recent study, at least one in five Americans takes some form of medication for mental illness.

Treating mental illnesses is expensive and people with poor or zero insurance coverage can often go in debt. Plus, medications can lead to long-term side effects.

Side effects exist with nearly every medication, but drugs treating mental illness often have greater risk. The basic warning symptoms for an antidepressant is, “Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, or adults within the first few months of treatment, weight loss or gain, lack of sleep or drowsiness.” And the list goes on.

The evidence that antidepressants can cause more harm than good is compelling. For instance, Peter Gøtzsche, professor and director of the Nordic Cochrane Centre in Denmark, asserts in his book British Medical Journal Debate that medicines for mental illnesses are ultimately ineffective. His views are strongly opposed by many mental health experts. However, Gøtzsche conducted many experiments with a placebo group for mainstream antidepressants. He found similar results for both the drugs and the placebo. In addition, he concluded that antipsychotic drugs may disrupt brain neurotransmitters and usurp the brain’s organic soothing functions.

The price of feeling better, of lifting the depression, of treating the psychosis, does not come cheap and leaves many drowning in bills and confusion. Many medications are expensive and insurance drops the price significantly. However, without insurance, medicines like Prozac and Lexapro cost up to $400 for 30 tablets. Meanwhile, Xanax takes in more money than Tide laundry detergent; overall, the American pharmaceutical industry generates revenue in the billions, if not trillions, of dollars, according to Charles Barber, an author known for his work and research into mental illnesses. Most people rely on their insurance plans to cover medications, but tens of millions of people are without health insurance. Medication for mental illness alone nets drug companies $16.4 billion a year. Debt and mental illness feed off each other in this viscous cycle.

Since 1952, the American Psychiatric Association has published the Diagnostic and Statistical Manual of Mental Health Disorders; it’s the standard classification of mental disorders. This includes almost every known mental illness and is constantly updated. Using information from the DSM, various groups sponsor lectures, fundraisers and conferences where information is shared with psychiatrists and psychologists.

However, at these events, people called key opinion leaders, via their writings, influence medicines and treatments for mental illness. Several reports by Marcia Angell, a senior lecturer in social medicine at the Harvard University medical school and former editor of The New England Journal of Medicine, show that these leaders have significant financial ties to big pharmaceutical companies, which would cause them to push certain drugs and force certain treatments, including all the contributors to the section on mood disorders and schizophrenia. This is not the first time higher powers have influenced or made major changes to the treatment of mental health patients.

On top of these problems are the tens of thousands of people who are mentally ill and homeless. The deinstitutionalization of mentally ill began in 1955 with the widespread introduction of chlorpromazine, commonly known as Thorazine, the first effective antipsychotic medication. Use of this drug increased 10 years later with the enactment of federal Medicaid and Medicare.

Deinstitutionalization has two parts: the moving of the severely mentally ill out of state institutions, and closing part or all of those institutions. In January 2015, 564,708 people were homeless on any given night in the United States. About 15 percent of the homeless population, 83,170, are considered “chronically homeless” individuals. More than 124,000, or one-fifth, suffer from a severe mental illness, according to the U.S. Department of Housing and Urban Development. A widespread misperception is that it’s cheaper to medicate these mentally ill homeless people than to provide them safe, humane places to live.

Harm has been done and it is up to us as a society to find a positive way to treat all people with mental illness. We would not deny treatment to a cancer patient or someone one with Alzheimer’s disease or any other disease. We would treat them.

Plus, the medications in treating mental illnesses are all relatively new. For instance, we have found a way to preserve our bodies to the average age of 80, but we have not found ways to keep our minds sharp and effective for that long.

Nobody can change a disease, but we can change how we see the disease. We spend so much time seeing dollar signs, and side effects, and mistakes that we don’t see people suffering. We don’t see people getting lost in the statistics. It is time we see them. It is time we see the reality of mental illness, not how much the medicine costs, not how many people are in it for the money, not questioning if the disease is real or not.